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November 16, 1995

An Epidemiologic Study of Lyme Disease in Southern Sweden

Johan Berglund, M.D., Rickard Eitrem, M.D., Ph.D., Katharina Ornstein, M.D.


Background Lyme disease is the most common vector-borne infection in some temperate regions of the Northern Hemisphere. However, for most areas of endemic disease reliable epidemiologic data are sparse.

Methods Over a one-year period, we conducted a prospective, population-based survey of cases of Lyme disease in southern Sweden. The diagnosis was made on the basis of the presence of erythema migrans at least 5 cm in diameter or characteristic clinical manifestations such as arthritis, neuroborreliosis, and carditis.

Results We identified 1471 patients with Lyme disease, for an overall annual incidence of 69 cases per 100,000 inhabitants. The incidence varied markedly according to geographic region, and there were several areas where disease was widely prevalent. The incidence varied according to age, with the highest rates among people 5 to 9 and 60 to 74 years of age, but not according to sex.

[I do not know how common the EM rash or bulls-eye rash is in Lyme disease. I do not believe it is routine or common. I also do not believe any person in the world knows how often Lyme causes a bulls-eye rash].

J Clin Microbiol. 2000 June; 38(6): 2097-2102.

American Society for Microbiology

A European Multicenter Study of Immunoblotting in Serodiagnosis of Lyme Borreliosis

J. Robertson, E. Guy, N. Andrews, B. Wilske

A European multicenter study of immunoblotting for the serodiagnosis of Lyme borreliosis showed considerable variation in results obtained from tests with a panel of 227 serum samples. Six laboratories used different immunoblot methods, and a wide range of bands was detected in all the assays. Multivariable logistic regression analysis of data from individual laboratories was used to determine the most discriminatory bands for reliable detection of antibodies to Borrelia burgdorferi sensu lato. These bands were used to construct individual interpretation rules for the immunoblots used in the six laboratories. Further analysis identified a subset of eight bands, which were important in all the laboratories, although with variations in significance. Possible European rules, all closely related, were formulated from these bands, although there was no single rule that gave high levels of sensitivity and specificity for all the laboratories. This is a reflection of the wide range of methodologies used, especially the use of different species and strains of B. burgdorferi sensu lato. The panel of European rules provides a framework for immunoblot interpretation which may be adapted in relation to the characteristics of Lyme borreliosis in local areas...

The clinical diagnosis of Lyme borreliosis (LB) can be difficult because symptoms, other than a typical erythema migrans (EM) of early infection, may be of a nonspecific nature. In addition, the interpretation of laboratory diagnostic test results has been problematic because of wide variation in the sensitivities and specificities of the tests used.

Immunoblotting is both sensitive and specific, has been in wide use in diagnostic laboratories, and in the United States has been recommended as a confirmatory test for the serodiagnosis of Lyme disease. However, in Europe an extensive range of blotting methodologies is in use ... and although recommendations on the interpretation of band patterns have been published in Europe and the United States no consensus exists.

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